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Specification:

US Da Vinci PDex (FHIR)
Raised in Version:

current
Work Group:

Financial Mgmt
Related URL:
http://build.fhir.org/ig/HL7/davinci-epdx/USCoreProcedure.html#health-plan-mapping-assistance
Related Page(s):

(NA)
Related Section(s):
4.3.26.0.1
Grouping:
- Block-Vote-6
Resolution Description:

Hide

EOB and CPCDS mapping table updated as proposed

Procedure.reasonCode mapping changed.

Procedure.reasonCode 0..* ExplanationOfBenefit.diagnosis.diagnosis [\{“22, 23”:”Diagnosis Code”}]

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EOB and CPCDS mapping table updated as proposed Procedure.reasonCode mapping changed. Procedure.reasonCode 0..* ExplanationOfBenefit.diagnosis.diagnosis [\{“22, 23”:”Diagnosis Code”}]
Resolution Vote:
Bob Dieterle / Chris Johnson: 12-0-1
Change Category:
Correction
Change Impact:
Non-substantive
Pre Applied:
Yes
Applied for Version:

1.0.0

According to the mapping assistance, the procedure done and the reason the procedure was done comes from the same CPCDS Element.

Procedure.code

1..1

[{“24, 26, 146”:”ICD Procedure Code”}, {“40”:”Procedure Code - CPT / HCPCS”}

Procedure.reasonCode

0..*

ExplanationOfBenefit.procedure.procedure, ExplanationOfBenefit.item.productOrService

[{“24, 26, 146”:”ICD Procedure Code”}, {“40”:”Procedure Code - CPT / HCPCS”}

The way this reads to me is "I performed an Appendectomy because you had an Appendectomy".

Personally I would think the reason should be a diagnosis (or other procedure). Perhaps like this:

Procedure.reasonCode

0..*

ExplanationOfBenefit.diagnosis.diagnosis

[{“22, 23”:”Diagnosis Code”}